Provider Demographics
NPI:1891251302
Name:BRUNSON, CHELSEY ALEXIS
Entity type:Individual
Prefix:
First Name:CHELSEY
Middle Name:ALEXIS
Last Name:BRUNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 HAWTHORNE DR
Mailing Address - Street 2:
Mailing Address - City:TINTON FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-7596
Mailing Address - Country:US
Mailing Address - Phone:848-469-0533
Mailing Address - Fax:
Practice Address - Street 1:34 HIGHWAY 35 N
Practice Address - Street 2:
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-4743
Practice Address - Country:US
Practice Address - Phone:848-469-0533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-20
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty